WA State COVID-19 Like Illness (CLI) RHINO Surveillance Report March 22, 2010 Note: Data for week 12 (ending 3/21) is incomplete. Caution is advised in interpreting week 12 data, especially for syndromes the search for discharge diagnoses. Executive summary:  COVID-19-like Illness (CLI): CLI includes subsyndromes of Fever or Chills AND Cough/Shortness of Breath/Difficulty Breathing. Subsyndromes are based entirely on key words in the initial chief complaint.  CLI: Emergency Department (ED) Visits for CLI have been statistically elevated across the state for the past 3 weeks and have continued to increase each week. The statistically significant elevation is observed in all age groups and over half of the counties across the state. Hospitalizations for CLI are statistically elevated across the state for week 12. The statistically significant elevation is observed in all age groups >5 years and in 16/39 (41%) counties. Pneumonia: ED Visits and hospitalizations for pneumonia were statistically elevated across the state in the past two weeks. Elevations are observed in adult age groups. Regionally, 9/39 (23%) of counties are experiencing statistical elevations in ED visits and 3/39 (8%) are experiencing statistical elevations in hospitalizations for pneumonia in week 12. Influenza and coronavirus diagnoses: Influenza diagnoses have been decreasing the past 2 weeks in all age groups. In contrast, both coronavirus diagnoses (including all coronavirus, not limited to COVID-19) is has been increasing in that past 4 weeks, particularly in patients 18+, with the largest increases noted in the 65+ age group.   CLI ED Visits:  The percent of ED Visits for CLI has been statistically elevated for the past 3 weeks. In week 12, there were 1812 ED visits for CLI reported. 1  ED visits for CLI have been statistically elevated in all age groups for 3 weeks, with the exception of the 0-4 yo age group, which is only elevated in the past 2 weeks. While the absolute percentage of CLI visits in older adults is small compared to younger age groups, the elevation in all age groups ≥18 years have far exceeded the levels that were observed earlier this season for influenza and in the 2018-19 winter season. The elevation in the younger age groups is similar to what was seen during the peak of the 2019-20 influenza season in late 2019. 2  The percent of ED visits for CLI is statistically elevated at Emergency Departments in 23/39 (59%) counties (Asotin, Benton, Chelan, Clark, Cowlitz, Grant, Grays Harbor, Jefferson, King, Kitsap, Klickitat, Lewis, Mason, Pierce, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Whitman, and Yakima counties) in week 12. Several counties have been statistically elevated for 2-3 weeks and in most counties, the 3 current elevation is exceeding peaks observed earlier in the year. Counties with zero visits may either not have any CLI visits identified, or they do not send data to RHINO currently. CLI Hospitalizations: 4  The percent of hospitalizations for CLI is statistically elevated for week 12. CLI hospitalizations have been increasing for the past 3 weeks. In week 12, there were 254 hospitalizations for CLI reported.  CLI Hospitalizations are statistically elevated in age groups (5+ years) in week 12. All adult age groups have been elevated for 2 weeks and the elevations have far exceeded peaks observed previously this year. 5  In Week 12, CLI hospitalizations are statistically elevated at hospitals in 16/39 (41%) counties (Benton, Chelan, Clark, Cowlitz, Franklin, Grays Harbor, King, Kitsap, Lewis, Pierce, Skagit, Snohomish, Spokane, Thurston, Walla Walla, and Yakima counties). Nine counties have been statistically elevated for at least 2 weeks and these levels are often exceeding what has been observed so far this year. Counties with zero visits may either not have any CLI visits identified, or they do not send data to RHINO currently. 6 Pneumonia ED Visits:  The percent of ED Visits for pneumonia has been statistically elevated for two weeks. In week 12, there have been 1,320 ED visits for pneumonia reported. 7  ED visits for pneumonia were statistically elevated in weeks 11 and 12 for all adult age groups and exceeded the levels observed earlier this season. 8  The percent of ED visits for pneumonia is statistically elevated in 9/39 (23%) counties (Benton, Clark, Cowlitz, King, Kittitas, Snohomish, Whatcom, and Yakima counties). Pneumonia ED visits have been statistically elevated in King and Snohomish counties for 2-3 weeks. Counties with zero visits may either not have any CLI visits identified, or they do not send data to RHINO currently. 9 Pneumonia Hospitalizations:  The percent of hospitalizations for pneumonia is statistically elevated for week 12 and is increasing. In week 11, we surpassed the previous season peak (6.9% in week 1 vs. 7.2% in week 12). For week 12, 796 pneumonia hospitalizations were reported. 10  Pneumonia hospitalizations are statistically elevated in adults 45+ years of age in weeks 11 and 12. 11  In week 12, pneumonia hospitalizations are statistically elevated at hospitals in 3/39 (8%) of counties (King, Pierce, and Snohomish counties). Snohomish County has been statistically elevated for the past 3 weeks, King - 2 weeks, and Pierce - 1 week. Counties with zero visits may either not have any CLI visits identified, or they do not send data to RHINO currently. 12 Trends in influenza and coronavirus diagnoses:  Statewide, influenza diagnoses given at ED visits have been on a downward trend for the past 2 weeks. In contrast, starting in week 9, we have seen a large increase in ED visits with a coronavirus diagnosis. Coronavirus diagnoses include all coronaviruses including COVID-19. The recent increase in coronavirus diagnoses is most obvious in the 65+ age group, and to a lesser degree 18-64 year olds. No such discernable increase in coronavirus diagnoses is noted in people <18 years of age. 13  The percent of ED visits with a flu diagnosis have been decreasing in the 65+ age group for the past two weeks, while the percent of ED visits with coronavirus diagnoses are statistically elevated in the past 3 weeks in the 65+ age group. Data Notes: Analyses are based on information reported to the Rapid Health Information NetwOrk (RHINO). At the date of this report, 84/100 (84%) Emergency Departments in the state submit data to RHINO. Data are preliminary and may change. These data are intended to be used for surveillance purposes only. While some visits of interest may be missed and others that are not of interest included, the intent is to monitor 14 trends in syndromes that may be sensitive to circulation of COVID-19 in the community. Counts reflect visits or hospitalization events, not unique individuals. Dates are the date that the visit or hospitalization began. Counts and percents are not cumulative. Syndrome Definitions COVID-19-like Illness (CLI): CLI includes subsyndromes of Fever or Chills AND Cough/Shortness of Breath/Difficulty Breathing. Subsyndromes are based entirely on initial chief complaint and look for key words in the chief complaint that match with the concept (e.g., “feeling hot”). Pneumonia: Includes records with a chief complaint containing the term pneumonia or a diagnosis of pneumonia. Statistical Alerts Statistical alerts are only shown for the 2019-2020 season. Yellow points are statistical warnings (p<0.05) and red points are statistical alerts (p<0.01). The CDC-C2 algorithm was used. The C2 algorithm subtracts the weekly proportion from the mean of a moving baseline ending 3 weeks earlier, with the baseline being 28 weeks in length. In effect, it then divides this difference by the standard deviation of counts in that baseline. If the result exceeds 3, indicating an increase above the mean of more than 3 standard deviations, an alert is issued. Limitations: The methods take no account of systematic data behavior such as day-of-week effects or seasonal trends. Threshold data values for alerting may fluctuate noticeably from day to day. 15